Thomas Clark Banever, M.D. – Surgery Physician

Key facts

NPI: 1992799498
Entity type: Individual (NPI type 1)
Primary specialty: Surgery Physician 208600000X
License: 016245 (CT)
Practice address: 100 Retreat Ave
Suite 808
Hartford, CT 06106-2528
Phone: (860) 249-9189
Fax: (860) 249-9180
NPI assigned: Sep 12, 2005
Sex: Male
Sole proprietor: Yes

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Hartford Hospital General Acute Care Hospital · Hartford, CT · NPI 1770696643

Care Compare affiliation Hospital
Hartford Hospital General Acute Care Hospital · Hartford, CT · NPI 1902834880

Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty: General Surgery
Education: Tufts University School of Medicine, 1972
Medicare assignment: Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

100 Retreat Ave
Suite 808
Hartford, CT 06106-2569
Phone (860) 249-9189

Hospital & facility affiliations

Hartford Hospital Hospital · Hartford, CT · CCN 070025

Procedures performed for Medicare patients

Procedure	Number of procedures
Hernia repair - groin (open)	1-10
Melanoma (skin cancer) excision	1-10
Removal of tissue	34

Medicare participation

Medicare fee-for-service enrollment: Enrolled in CT
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20040504001481	CT	Practitioner - General Surgery	3375531700	Practice locations: Hartford, CT

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
016245	CT	MD	Surgery Physician

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Surgery Physician	208600000X	016245	CT	Yes

Addresses

Primary practice location

100 Retreat Ave
Suite 808
Hartford, CT 06106-2528

Mailing address

100 Retreat Ave
Suite 808
Hartford, CT 06106-2528
Phone (860) 249-9189

Other identifiers

Identifier	Type	State	Issuer
00162452	Medicaid	CT

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992799498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 RETREAT AVE",
            "address_2": "SUITE 808",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061062528",
            "telephone_number": "860-249-9189",
            "fax_number": "860-249-9180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 RETREAT AVE",
            "address_2": "SUITE 808",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061062528",
            "telephone_number": "860-249-9189",
            "fax_number": "860-249-9180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANEVER",
        "first_name": "THOMAS",
        "middle_name": "CLARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CT",
            "license": "016245",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00162452",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

All providers in Hartford, CT · Surgery Physician in Connecticut

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.